| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,954 |
7,954 |
$293K |
| D1120 |
Prophylaxis - child |
5,861 |
5,860 |
$228K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,807 |
1,441 |
$175K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,659 |
7,659 |
$111K |
| D0272 |
Bitewings - two radiographic images |
3,496 |
3,496 |
$93K |
| D1110 |
Prophylaxis - adult |
1,727 |
1,727 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
4,461 |
4,442 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,216 |
1,149 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,376 |
1,372 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,631 |
3,583 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
515 |
290 |
$48K |
| D2140 |
|
473 |
289 |
$28K |
| D0330 |
Panoramic radiographic image |
328 |
328 |
$27K |
| D2160 |
|
105 |
66 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
62 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
96 |
$4K |
| D1351 |
Sealant - per tooth |
93 |
39 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
27 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
40 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
70 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
24 |
$2K |